Readily A Parent

Why don't we make people vaccinate?

In my last column, I talked about the evolution of my own choice over whether or not to vaccinate my children. Some people can’t believe such a choice exists.

After all, immunization is a public health measure, for the good of entire communities and we all understand there are many instances when the risk to public safety outweighs an individual’s choice.

We might choose to drive at 200 kilometres an hour, but there are laws against it. We also have laws to protect children from their parents’ choices.

A parent may decide car seats are ineffective and overpriced and choose not to use them, but there are laws in place to ensure parents do use car seats.

The difference, however, is neither the rate you drive your car nor the choice to buckle up or not involves an action requiring a potential risk situation. No one has been hurt by driving slower, and putting your child in a car seat does not open them to any risk at all.

Injecting your child with a substance, which you as a parent may question the safety of, is far different from strapping your child into a car seat.

As Jane Henderson, PhD candidate in bioethics at Memorial University’s Faculty of Medicine – and mom of two – said “I don’t believe everything that is put in front of me. Questioning what is happening to your kids, and what you are injecting them with, shows good parenting.

“But, we have a fiduciary relationship with health care professionals and we need to live under the assumption that that relationship is being honoured.”

In most cases, when it comes to vaccination, the trust we place in our health professionals to have made the right choice is well placed. But for some individuals there are reactions to those injections.

They are not 100 per cent risk-free and that is why there is the choice, as there is for most medical treatment.

“Two of the founding principles of bioethics are autonomy, wherein each individual has the right to make independent choices and decisions, and non-maleficence, to do no harm or to avoid imposing unnecessary or unacceptable burden upon the patient.”

Jane explains a child cannot be autonomous so their parents’ choice is honoured.

I asked her how this compared to cases where parents refuse medical interventions for their children, and are later forced to accept those interventions. Such court cases have been sensationalized in the media.

Why don’t those same principles – that the parent is incapable of making the right decision because of personal attitude or religious belief – apply to vaccinations?

Jane replied “Parents – as substitute decision makers – can decide the right medical path and that is accepted unless it will cause harm. Then the non-maleficence comes into play. So in cases where it is life or death and, here is the thing, the child would have a good chance at recovery and living a normal life – then they would intervene.

“Like I said, bioethics is focused on those two points autonomy and non-maleficence. When autonomy is not available – or not believed to be in the best interest of the child – and it is believed the child can survive and live a good quality of life, then legal steps are taken.”

But in the case of vaccinations, the child is not at immediate risk and the parent’s choice cannot be seen as leading directly to the child’s death or severe curtailment of their enjoyment of life. Not vaccinating your child with the standard childhood vaccinations causes no direct harm.

If it is the parents’ strong belief vaccinating their child does pose an unacceptable risk, then according to the way we govern our society, forcing vaccination could impose an unacceptable burden.

But what of situations, like in epidemics, where the principle of non-maleficence, is reversed? By a parent refusing vaccination of their child they can then turn their child into a vector of harm for other people’s children.

In some cases, especially in fatal epidemics, we are able to identify who introduced a disease into a community.

If a child whose parents refused vaccination infects another child who couldn’t receive vaccinations because of allergy or immunocompromised status and that child suffers great harm or dies, shouldn’t the parents of the affected child be allowed to pursue action against the other parents?

In their paper on the subject, ‘Could Parents Be Held Liable For Not Immunizing Their Children?’ researchers Rodal and Wilson state the main limitations are it is often impossible to prove an individual infected another; that there is a question of foreseeability – parents may not be aware when refusing vaccination they are putting others at risk; and under the status-quo, the principle of autonomy is accepted and exemptions to immunization are presented as personal choice rather than a question of community health.

However, they point out in many epidemics while it may be difficult to locate the individual who transmitted the disease to others, it is often evident a community of individuals were the original carriers – and those communities of geographic or social clusters could be held liable as a group.

In their paper they propose the way in which allowed vaccination exemptions are framed should be changed from the idea it is an equally acceptable option for immunization to the concept it is ‘a risky choice for which one ought to be liable should things go wrong’.

They state:

‘Civil liability could prove to be a helpful factor in changing the tides of vaccine acceptance. It could provide some recourse to parents who have complied with public health recommendations but who are harmed by the choices of others, and could aid in changing social attitudes, which will help in avoiding large-scale outbreaks of measles and other preventable diseases.

Due to the availability of a statutory defense for conscientious objectors, as well as a lack of clarity in the current standard of care across the country, it appears unlikely a parent or their affected child could currently succeed in a lawsuit. We would argue government and public health authorities should move to clearly state the immunization of school-aged children is a public health and safety requirement benefiting the greater community.

Exemptions should remain a personal choice, but they should be reframed as one that does not negate liability if it results in a foreseeable and identifiable harm’.

While the decision to vaccinate is an autonomous choice, which involves informed consent, herd immunity depends upon parents making the ‘right’ choice.

As Rodal and Wilson state, “It is not simply a public good versus an individual good, but a public good versus a public harm. That is, each non-medically based choice to avoid vaccination contributes to the risk of public harm.”

So while it may be impossible, unethical and against our current climate of choice to force parents to immunize their children, we also need to make it clear the decision to not vaccinate carries risk, not just for their own child, but for all children!

Our judicial system says although we may not be criminally liable for decisions and choices that affect others, we can be held civilly liable for those same choices.

Is refusing immunization for no reason other than conscientious objection a criminal act, or a choice that cannot be tolerated by society for the good of your child? No.

But it is a choice that has potential repercussions for others who have attempted to protect their child or who have not had the choice to immunize because of a medical condition. As such, the way we frame this choice needs to reflect that very real risk, not the hobgoblin risk of autism.

Dara Squires is a freelance writer and mom of three based in Corner Brook. You can contact her on facebook at ‘www.facebook.com/readilyaparent’.